This form should be filled out for all children ages infant – 5th grade who are
involved in our nursery, toddler, KidsClub, and Children’s Ministries.
Please complete this form once your child attends or becomes involved
in our Children’s Ministry.

(If you have filled out a paper Child’s Information form at church recently,
this form is identical and not necessary.)
Please renew this form at the beginning of each new school year
or when your child becomes involved.
Fill out a separate form for each child.

Todays Date (required)

Child's Full Name (required)

Date of Birth (required)

Child's Gender (required)

Child's Age (required)

Grade Level in School or list pre-k (required)

Parent's/Guardians Full Name (required)

Street Address (required)

City/State/Zip (required)

Best Phone Contact (required)

Alternate Phone Contact (required)

Your Email (required)

Who can pick up your child (required)

List allergies / medical conditions (required)

Non-parent Emergency Contact Name & Relationship to Child (required)

Non-parent Emergency Contact Phone (required)

Any additional information you would like to provide